Postpartum: Starting to Exercise Again

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Starting a moderate exercise program during the postpartum months is beneficial in many ways. Regular exercise improves immune function and increases the production of antioxidant substances in the body. It helps you to sleep better at night and feel more energetic during the day. A brisk walk does wonders for depression or anxiety. A bout of exercise helps to suppress your appetite for sweets and junk food and increases your appetite for natural, nourishing foods. Flexibility and muscular strength stave off uneven strain on the skeleton that can lead to pain and injury over time. If your muscles are strong and your joints supple, you are less likely to throw your back out or injure yourself in some other way as you lift, bend, twist, and maneuver through your day. And if you start easing into exercise in a balanced and educated manner during the first postpartum year, the transition into more strenuous exercise later  should you choose to make that transition  is sure to be much smoother.

While some exercise is a very good thing for a new mom, doing too much too soon can be harmful. This is especially true for women who are low on the adrenal hormone cortisol. When you exercise, your adrenal glands pump out cortisol to increase your heart rate and breathing rate, and to increase blood flow to your muscles. As explained previously, there is a significant drop in cortisol levels postpartum. Going out for a run two weeks after giving birth will draw on the tapped resources of your adrenals before they are ready, and this will knock your recovering body out of balance. If laboratory tests show that your cortisol levels are low, you should postpone all but the most mild exercise until those levels return to normal.

You may have enjoyed an increased degree of flexibility during pregnancy. Your joints will still be loose for the first few weeks postpartum, and loose ligaments mean greater risk of injury. Exercising too hard in those first weeks can also delay the healing of episiotomy and cesarean incisions. If you hemorrhaged after giving birth, you may be anemic, and you will need to build up your iron levels for a while before you're ready to exercise.

Unrelenting or recurring muscle or joint pain in the hips, legs, or back can be related to the skeletal strain of late pregnancy and birth. If you have this problem, you may need to visit a skilled chiropractor or osteopath, who can assess any skeletal imbalances and correct them.

Starting to Exercise Again
An important point to remember about exercising postpartum is that you should not start too soon. But how soon is too soon? There are conflicting opinions on this. Some experts recommend waiting six weeks to do any exercise at all, while others tell new mothers that they can start as soon as the day after they give birth. In some rare instances, women are truly well enough to get up and walk a short distance the day after giving birth. This is more likely to be true of women who have given birth a few times before, and whose bodies are used to the transition into postpartum. On the other end of the continuum are women who have had a complicated birth and difficult recovery. Such women may need a full six weeks of rest before moving their bodies in any kind of vigorous way. Most women, however, fall somewhere between these two extremes. We recommend that new mothers do nothing but rest and recover for a full two weeks postpartum.

The First Two Weeks
For the first couple of days, if at all possible, stay in bed with your baby, nursing as often as possible and getting up only to use the bathroom and to do herbal sitz baths. One woman we know absolutely had to have a shower only three or so hours after giving birth to her first baby, and hobbled into the bathroom alone while her husband and baby dozed. She sustained a good smack on the head when she fainted in the stall. If, during those first few hours, you feel a sponge bath just doesn't get you clean enough, take a shower with your partner  sit on a stool and let him wash you and rinse you off (a hose attachment for your shower helps a great deal with this, and is a good thing to have for bathing your baby).

After the first two days, ease into regular activity gradually. Don't think that after a little bed rest you should scour the house and cook a three-course meal while your baby sleeps. Many expectant families enlist the help of friends and family, setting up a schedule that allows others to help out by bringing home-cooked meals and helping with chores and the care of older children.

One exception to this guideline: You can start doing Kegel exercises as soon as the day after giving birth. Hopefully, your doctor instructed you in how to do these, and advised you to do them regularly during pregnancy. If you haven't been doing Kegels, here's the basic exercise: Contract the muscles in your vagina as though you were holding back the flow of urine, and hold them that way for ten seconds at a time. Then relax. Do this whenever you think to do so, building up to five sets of ten repetitions three to four times a day. Kegels help to keep blood flowing to your genital and perineal areas, encouraging your body to heal from tearing, swelling, or bruising. They help to tone and firm the muscles in the vagina, counteracting that feeling some women have that their insides are going to slide out of them through their vaginas after giving birth. Kegels also help to control the leaking of urine that affects some women postpartum.

In some cultures, it is common practice for women to bind their bellies after giving birth. While belly binding is not medically necessary, and may not do anything to improve your shape, some of our patients tell us that it does feel quite good to gather everything in tightly. Belly binding may even help to speed the knitting together of separated abdominal muscles.

Some sporting goods stores sell snug midriff wraps that close with Velcro. Many women's clothing stores now sell camisoles, tank tops, or tube tops made from stretchy combinations of cotton and Lycra. Before your baby is born, look around and see if you can find anything like this to keep handy postpartum. If you have already had your baby, send a friend or relative out to search for something that feels snug and secure and allows you to nurse and rest comfortably.

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